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Aorto-femoral graft infections: a clinical and microbiological analysis
C Santini1, P Baiocchi, M Venditti
1Servizio Aggregato di Consulenze Infettivologiche, Università La Sapienza, Rome, Italy.
Abstract:
A 5-year experience of 19 aortic graft infections is reviewed. Of these, 13 (68%) had a late onset (more than 4 months after graft implantation) and usually presented with anastomotic pseudo-aneurysm or thrombosis. The remaining six infections (32%) had an early onset and presented more often with surgical wound infection. Aorto-enteric fistulae and inguinal sinus tracts were observed in both early and late onset infections. Coagulase-negative staphylococci (all slime negative, oxacillin susceptible strains) were the prevalent pathogens in both groups of infections and were isolated in six (32%) patients. Next most commonly seen were Pseudomonas aeruginosa in four (21%) patients, Enterococcus spp. in three (16%) patients, Staphylococcus aureus in three (16%) patients, other bacteria in six (32%) patients. No organisms were isolated in three (16%) patients. Mortality and major amputation rates were 47.3% and 31.6%, respectively. The therapeutic procedures included total graft removal (15 patients), partial graft excision (two patients), partial graft excision followed by total graft removal (one patient) and local treatment without graft removal (one patient). Six patients recovered, including two who underwent total graft removal associated with a non-conventional 'in situ' graft replacement and one patient treated conservatively with local treatment and antibiotics. The three patients undergoing partial graft excision showed signs of active infection of the residual graft.
Insights
Aortic graft infections, often caused by Staphylococcus, have high mortality and amputation rates. Early detection and aggressive treatment, including graft removal, are crucial for better outcomes.
Area of Science:
- Vascular Surgery
- Infectious Diseases
Background:
- Aortic graft infections pose significant challenges in vascular surgery.
- Understanding the epidemiology and clinical presentation is vital for effective management.
Purpose of the Study:
- To review a 5-year experience with aortic graft infections.
- To analyze the onset, presentation, pathogens, treatment, and outcomes of these infections.
Main Methods:
- Retrospective review of 19 cases of aortic graft infections over 5 years.
- Analysis of patient demographics, infection onset, clinical presentation, isolated pathogens, and treatment strategies.
Main Results:
- Late-onset infections (68%) commonly presented with pseudo-aneurysm or thrombosis; early-onset (32%) with wound infections.
- Coagulase-negative staphylococci were the most prevalent pathogens (32%), followed by Pseudomonas aeruginosa (21%).
- High rates of mortality (47.3%) and major amputation (31.6%) were observed. Total graft removal was the most common therapeutic approach.
Conclusions:
- Aortic graft infections are associated with severe morbidity and mortality.
- Prompt diagnosis and surgical intervention, often involving graft removal, are essential.
- Further research into novel treatment strategies, including 'in situ' graft replacement, may improve patient outcomes.